ObesityWeek 2016: 5 Studies to Watch

Published in November Issue             

First national quality improvement program for weight loss surgery reduces readmissions by more than 30% for some hospitals

Results from the first national quality improvement program for weight-loss surgery, which were presented for the first time at ObesityWeek 2016, drew interest for its success in reducing hospital readmissions by more than 30 percent for some and by about 14 percent for the average hospital.

The Decreasing Readmissions through Opportunities Provided (DROP) program is the first initiative focused on hospital readmissions developed through Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), a joint program of the American College of Surgeons (ACS) and the ASMBS.

“We saw readmissions as an area we could
improve even further,” said lead study author
John M. Morton, MD, Director of Bariatric Surgery at Stanford Hospital & Clinics and immediate past-president, ASMBS. “Through a true collaboration among hospitals and centers, we bundled best pre-operative and post-operative programs and practices that focused on key triggers for readmissions, taking advantage of a bariatric program’s multi-disciplinary approach.”

In the study, DROP was implemented by 128 MBSAQIP Comprehensive Centers between March 2015 and March 2016 for patients undergoing primary laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, or laparoscopic Roux-en-Y gastric bypass. In the year prior to the program, centers had a 30-day readmission rate of 4.79 percent with 1,446 readmissions from 30,204 cases. Six months after starting the DROP program, the readmission rate had fallen by an average of 14 percent. The reduction in readmissions was more than three times that (32%) for hospitals in the top quartile of readmissions before the start of the program.

DROP components spanned preoperative to postoperative services including educational videos, inpatient nutritional consults, medication management, postop surgeon and nutritionist visits, and discharge checklists. Of the eight interventions, the post-operative visit with the nutritionist had the most impact.

Gastric bypass patients significantly reduce risk of dying from obesity and other diseases, new study suggests

Patients with severe obesity who have gastric bypass surgery reduce their risk of dying from obesity and other diseases by 48 percent up to 10 years after surgery, compared to similar patients who do have the procedure.

Researchers from the Geisinger Health System followed nearly 2,700 patients who had gastric bypass at the system’s nationally accredited bariatric surgery center between 2004 and 2014. Mortality benefits began to emerge within two years after surgery and were significant within four years. The biggest reduction in risk occurred in patients 60 years or older at the time of surgery and in patients who had diabetes before surgery.

Michelle Lent, PhD

“The long-term survival benefits these older patients and those with diabetes experience likely relate to improvements in long-term metabolic and cardiovascular health, among other risk factors,” said Michelle R. Lent, Ph.D., a Geisinger Obesity Institute researcher, who presented her team’s findings.

In the study, more than 60 percent of patients with diabetes before surgery experienced diabetes remission about five years after surgery. Previous studies have shown death from heart disease and even certain cancers are lower in gastric bypass patients than patients with severe obesity who do not have the operation.

“Until recently, older age was viewed as a relative contraindication to bariatric surgery, as the benefits were less clear. Our findings help to challenge that myth and instead support offering the surgery to older patients,” Dr. Lent added.

New study shows balloon in a capsule helps patients lose nearly twice as much weight than diet, exercise and lifestyle therapy alone

Aurora Pryor, MD

Patients with obesity who swallowed gas-filled balloon capsules designed to help them eat less, lost 1.9 times more weight than patients who relied on diet, exercise and lifestyle therapy alone.

“The significant weight loss achieved with the Obalon 6-Month Balloon System is maintained at 12 months,” said Aurora Pryor, MD, study
co-author and Chief Bariatric, Foregut and Advanced GI Surgery, Stony Brook University. “This combination of lifestyle modification and balloon therapy provides a new low risk option for patients struggling with obesity.”

New study shows women have lower risk of heart disease after weight-loss surgery than men

Women have about a 20 percent less chance of developing heart disease after weight-loss surgery than men, according to new research.

According to researchers from Stanford University School of Medicine, while both genders significantly reduce their risk of developing cardiovascular disease over a 10-year period, women seem to benefit more. One year after surgery, women reduced their risk by 41 percent, while men reduced their risk of heart disease by 35.6 percent.

“This study shows there is a gender disparity in cardiac outcomes for patients undergoing bariatric surgery,” said lead study author John M. Morton, MD, Director of Bariatric Surgery at Stanford Hospital & Clinics and immediate past-president, ASMBS. “The findings suggest that women may have an enhanced mechanism of response to bariatric surgery, which leads to greater normalization of biochemical cardiac risk factors.”

New study suggests weight-loss surgery patients do better if they stick to scheduled follow up visits

Weight-loss surgery patients who stick to a schedule of 3-, 6- and 12-month follow-up visits with their doctors see greater improvements or remission of their diabetes, high blood pressure and high cholesterol than patients who skip their visits.

In the study, researchers from the Brody School of Medicine at East Carolina University in Greenville, NC reviewed the results of 38,613 patients who had three follow-up visits (complete follow-up) and compared them to the results of 12,468 patients who only had one or two follow-ups (incomplete follow-up). Data came from the Bariatric Outcomes Longitudinal Database (BOLD) from 2007 to 2012.

After one year, 62.3 percent of patients with complete follow-up saw their type 2 diabetes go into remission, while those who missed a visit or two had a remission rate of 57.5 percent. The rate of improvement in diabetes was also better for those who made all three visits (74.6% vs. 68.9%). The differences between the two groups also held for high blood pressure and lipid abnormalities including high cholesterol.

“This study shows there is great value in seeing patients at routine intervals after surgery in terms of health outcomes,” said Andrea Schwoerer, MD, a study co-author, currently at Carolinas Medical Center. “Unfortunately, many patients, reportedly as many as 50 percent, are lost to follow-up and therefore may not benefit as much as they can from weight-loss surgery, no matter how well it was performed.”